Remote controlled medical instrument

ABSTRACT

A wire section ( 1 ) inserted into a patient includes a wire ( 4 ) connected with a snare ( 3 ) at the front end thereof, and an outer tube ( 8 ) which retractably passes the wire ( 4 ) and the snare ( 3 ) therein. A remote control section ( 2 ) not inserted into the patient&#39;s body includes a bar-like main body ( 9 ) with a hollow inside; an operating member ( 11 ) connected to the main body ( 9 ) so as to be slidable in L and R direction and sled to enter or exit the snare ( 3 ) into and from the outer tube ( 8 ); and a pinching mechanism ( 15 ) built in the main body ( 9 ) and connected to the operating member ( 11 ) for detachably pinching the pipe ( 6 ) connected to the rear end of the wire ( 4 ). The wire section ( 1 ) and the remote control section ( 2 ) are connected when the pipe ( 6 ) is pinched by the pinching mechanism ( 15 ), and the wire section ( 1 ) and the remote control section ( 2 ) are separated when the pipe ( 6 ) is released from the pinching mechanism ( 15 ).

TECHNICAL FIELD

The present invention relates to a configuration of a remote controlledmedical instrument for performing procedures such as, polyp resection.

BACKGROUND ART

A remote controlled medical instrument for remote controlling anactuator inserted into the body and treating an object in the bodyincludes a polypectomy instrument for resecting the polyp formed in thebody, a body tissue collecting instrument for collecting a malignant orbenign tissue of the body and an internal foreign object extractinginstrument for extracting a foreign object taken inside the body.

The polypectomy instrument, serving by way of example as the aboveremote controlled medical instrument, conventionally includes amonopolar type and a bipolar type. The monopolar type includesinstruments such as that disclosed in Japanese Laid-Open PatentPublication No. 05-337130, and the bipolar type includes instrumentssuch as that disclosed in Japanese Laid-Open Patent Publication No.10-137261. FIG. 10 is a view showing the above mentioned monopolarpolypectomy instrument. In FIG. 10, the polypectomy instrument 50includes a wire section 51 inserted into the stomach or the intestinethrough an endoscope, and a remote control section 52 with which thedoctors performing the surgery control the wire section 51 outside ofthe body. H is a high-frequency generator for flowing high-frequencycurrent to the polypectomy instrument 50.

In the wire section 51, 53 refers to a snare serving as an actuator forresecting the polyp P formed at the wall W of the stomach or theintestine (the intestine herein). The snare 53 is an electrode formed byforming a steel stranded wire into a loop shape, and a high-frequencycurrent is flowed out from the high-frequency generator H, ashereinafter described. 54 is a wire made of a steel stranded wire withthe snare 53 coupled to the front end, and the rear end of the wire 54is coupled to the remote control section 52. 55 is a tube through whichthe wire 54 and the snare 53 pass in a freely entering and exitingmanner and is made of a flexible plastic. Here, only the wire 54 ispassed through the tube 55, but by pulling the wire 54 in the Rdirection, the snare 53 is deformed and accommodated inside the tube 55.

In the remote control section 52, 56 is a rod-shaped main body having ahollow inside, and a slit 56 a extending in the longitudinal direction Land R of the main body 56 is formed at the side face. A cap 57 forholding the rear end of the tube 55 to the front end of the main body 56is attached to the front end (L direction side) of the main body 56, andthe wire 54 is passed through the cap 57. 58 is an operating memberslidably coupled to the main body 56 in the L and R direction, and isformed with finger inserting holes 58 a, 58 b through which theforefinger and the middle finger are inserted. 59 is a male jack coupledto the operating member 58, and the rear end of the wire 54 is coupledto the root of a terminal 59 a at the center. Thus, when the operatingmember 58 is slide operated in the L and R direction, the wire 54coupled to the jack 59 is moved in the L and R direction, causing thesnare 53 to project out from the inside of the tube 55 or retract insidethe tube 55. Further, the jack 59 is fitted with a female jack 60, andis thereby connected to the high-frequency generator H by way of a cableCl. The high-frequency current generated at the high-frequency generatorH thereby flows out through the cable C1 and the jacks 60, 59 to thewire 54, and from the wire 54 to the snare 53. M is an externalelectrode attached to the abdomen or the buttocks of the patient, and isconnected to the high-frequency generator H by way of a cable C2. 61 isa pipe coupled to the operating member 58, and is arranged inside themain body 56. The pipe 61 passes the wire 54 therein and leads it to theoperating member 58. 62 is a finger holder coupled to the rear end (Rdirection side) of the main body 56, and is formed with a fingerinserting hole 62 a through which the thumb is inserted. When the thumbis inserted into the finger inserting hole 62 a, and the forefinger andthe middle finger are inserted into the finger inserting holes 58 a, 58b of the above mentioned operating member 58, the operating member 58 isslide operated in the L and R direction by the forefinger and the middlefinger while holding the main body 56.

The steps of resecting the polyp P formed at the wall W of the intestineand the operations of each part in the above polypectomy instrument 50will now be explained. First, two jacks 59, 60 are fitted together, andthe external electrode M is attached to the abdomen or the buttocks ofthe patient. Next, the wire section 51 is inserted into the intestine ofthe patient with the endoscope (not shown). Here, the operating member58 is sled to a position shown with a dotted line, the pipe 61 and thewire 54 are pulled in the R direction, and the snare 53 is retractedinside the tube 55. When the front end of the wire section 51 isinserted to a location where the polyp P is located, the operatingmember 58 is sled to a position shown with a solid line. The pipe 61 andthe wire 54 are thereby pushed in the L direction, causing the snare 53to project out from the inside of the tube 55, and the projected snare53 then encircles the base Pa of the polyp P. Here, in FIG. 10, sincethe projecting direction (U direction herein) of the polyp P and theloop surface of the snare 53 are parallel, even if the snare 53 is movedin the D direction, the snare 53 does not encircle the polyp P, and thusthe polyp P is rotated with the entire intestine with respect to thesnare 53 by having the patient change the body position to have theprojecting direction of the polyp P perpendicular to the loop surface ofthe snare 53, and the snare 53 then encircles the polyp P.

Further, when a polypectomy instrument 70 equipped with a rotatingmechanism part 71 is used as shown in FIG. 11, the snare 53 easilyencircles the polyp P without having the patient change the bodyposition. The reference characters of each part shown in FIG. 11 are thesame for parts similar to those in FIG. 10. In FIG. 11, the rotatingmechanism part 71 is arranged on the middle of the wire section 51, andis configured from a grip 72 gripped by the hand, a supporting pipe 73rotatably supported at the middle of the grip 72, and a roller 74 fixedto the peripheral surface of the supporting pipe 73. The supporting pipe73 passes the wire 54 therein and holds the wire 54. Due to suchrotating mechanism part 71, by rotating the roller 74 with the axis ofthe supporting pipe 73 as the rotating center, the supporting pipe 73and the wire 54 are rotated in the same direction as the roller 74, andthe rotational torque of the wire 54 is transmitted to the snare 53,thus rotating the snare 53 in the same direction as the roller 74.Therefore, the snare 53 is rotated with respect to the polyp P withouthaving the patient change the body position to have the projectingdirection of the polyp P perpendicular to the loop surface of the snare53, and the snare 53 then encircles the polyp P. Further, the surgerycan be performed without having the patient change the body position,and thus the load on the patient can be removed.

When the snare 53 encircles the polyp P as above, the high-frequencycurrent is flowed out from the high-frequency generator H to the snare53 through the wire 54. Thus, the high-frequency current is conductedfrom the base Pa of the polyp P encircled by the snare 53 through thebody of the patient and to the external electrode M, and heat generationas well as burning occurs at a portion of the polyp P having thesmallest cross sectional area. Subsequently, when the operating member58 is gradually sled to the R direction, the pipe 61 and the wire 54 arepulled in the R direction, causing the snare 53 to gradually retractinside the tube 55, and thus the base Pa of the polyp P is tightened bythe snare 53. Finally, the base Pa of the polyp is burnt off by theburning by the high-frequency current and the tightening force of thesnare 53, and the polyp P is resected from the wall W of the intestine.

In the conventional polypectomy instrument 50, 70, the wire section 51inserted into the body of the patient is discarded after the surgery inview of infection of disease and hygienic problems. However, since theremote control section 52 and the rotating mechanism part 71 areintegrally coupled to the wire section 51, the remote control section 52and the rotating mechanism part 71 not inserted into the body of thepatient are also discarded with the wire section 51, and thus the entireinstrument 50, 70 is disposable. This is a great waste when using theinstrument, and is a factor in the increase of facility cost ofhospitals and the like.

DISCLOSURE OF THE INVENTION

The present invention aims to overcome the above problems, and aims toprovide a remote controlled medical instrument in which the part notinserted into the body of the patient can be reused.

In the remote controlled medical instrument according to the presentinvention, the wire section includes a wire coupled with an actuator atthe front end thereof, and a tube for passing the wire and the actuatortherein in a freely entering and exiting manner; and the remote controlsection includes a rod-shaped main body having a hollow inside, anoperating member, coupled to the main body so as to be slidable in alongitudinal direction of the main body, for entering and exiting theactuator into and from the tube by sliding, and a pinching mechanism,built in the main body and coupled to the operating member, fordetachably pinching a rear end of the wire.

The coupling and separation of the wire section inserted into the bodyof the patient and the remote control section not inserted into the bodyof the patient are thereby freely carried out, and thus only the wiresection is discarded and replaced with a new one each time the surgeryis performed and thus the remote control section can be reused. As aresult, the wasteful use of the entire instrument can be eliminated, andthe facility cost necessary for surgery can be kept low.

Further, in the remote controlled medical instrument according to thepresent invention, the pinching mechanism is configured by a couplingmember for coupling the operating member and the wire, a clip member,arranged in the coupling member, for pinching the wire, and a slidingmember sliding independently from the coupling member in thelongitudinal direction of the main body, where the clip member ispreferably configured so as to pinch the wire in conjunction with thesliding of the sliding member in one direction and to release the wirein conjunction with the sliding of the sliding member in the otherdirection.

With the sliding operation of the sliding member, the clip memberdetachably pinches the wire, the operating member and the wire arecoupled or separated by way of the coupling member, and thus thedetachment operation of the wire to the operating member can be easilycarried out.

In addition, in the remote controlled medical instrument according tothe present invention, the above mentioned pinching mechanism isrotatably built in the main body with an axis of the longitudinaldirection of the main body as a rotating center, and can be configuredso as to rotate the pinched wire and the actuator in conjunction witheach other.

Thus, the pinching mechanism built in the remote control section alsofunctions as a rotating mechanism for rotating the actuator coupled tothe front end of the wire, and thus by reusing the remote controlsection each time the surgery is performed, the rotating mechanism isalso reused.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a view showing an entire polypectomy instrument, by way ofexample, of a remote controlled medical instrument according to thepresent invention.

FIG. 2 is an enlarged view of a wire section of the instrument.

FIG. 3 is an enlarged view of a remote control section of theinstrument.

FIG. 4 is a cross sectional view taken along line X-X in FIG. 3.

FIG. 5 is a cross sectional view taken along line Y-Y in FIG. 3.

FIG. 6 is a view showing a clip member of the polypectomy instrument.

FIG. 7 is a view explaining steps for coupling the wire section and theremote control section of the instrument.

FIG. 8 is a view explaining steps for resecting the polyp of theinstrument.

FIG. 9 is a view explaining steps for separating the wire section andthe remote control section of the instrument.

FIG. 10 is a view showing a conventional polypectomy instrument.

FIG. 11 is a view showing another conventional polypectomy instrument.

BEST MODE FOR CARRYING OUT THE INVENTION

The embodiment of the present invention will now be described withreference to the drawings. FIG. 1 through FIG. 6 are views explaining aconfiguration of a remote controlled medical instrument according to thepresent invention. FIG. 1 is a view showing the entire polypectomyinstrument as one example of a remote controlled medical instrument,where (a) is an outline view, and (b) is a cross sectional view. FIG. 2is an enlarged cross sectional view of a wire section in the instrument,where (a) is a cross sectional view of a front end, (b) is a crosssectional view of a rear end, and (c) is a cross sectional view takenalong line A-A in (b). FIG. 3 is an enlarged cross sectional view of aremote control section in the instrument. FIG. 4 is a cross sectionalview taken along line X-X in FIG. 3, and FIG. 5 is a cross sectionalview taken along line Y-Y in FIG. 3. FIG. 6 is a view showing a clipmember in the polypectomy instrument, where (a) is a plan view, (b) is aside view, and (c) is a perspective view seen from the B direction.Here, the reference character of each part in each view is denoted withthe same reference character for components similar to those in FIG. 10.

In FIG. 1(a), 100 is the polypectomy instrument, and in the presentembodiment, is a monopolar polypectomy instrument. The polypectomyinstrument 100 is configured from a wire section 1 inserted into thestomach or the intestine through the endoscope, and a remote controlsection 2 with which the doctors performing the surgery control the wiresection 1 outside of the body. H is a high-frequency generator forflowing high-frequency current to the polypectomy instrument 100.

In the wire section 1, 3 shown in FIG. 2(a) is a snare serving as anactuator for resecting the polyp formed at the wall of the stomach orthe intestine. The snare 3 is an electrode formed by forming the steelstranded wire into a loop shape, and the high-frequency current isflowed out from the high-frequency generator H, as hereinafterdescribed. 4 is a wire formed without twisting the three single wires,and the snare 3 is coupled to a front end (L direction side) of the wire4. A stainless pipe 5 is used for coupling the front end of the wire 4and the snare 3, and the pipe 5 passes and caulks each the wire 4 andthe snare 3 therein. Further, as shown in FIG. 2(b), the rear end (Rdirection side) of the wire 4 is caulked to a long stainless pipe 6, anda rear end 6 a of the pipe 6 is subjected to crush machining and is madeflat.

7 is an inner tube for passing the wire 4 therein and is made of aflexible plastic. As shown in FIG. 2(c), the inner tube 7 has an innerdiameter to an extent of passing three single wires configuring the wire4 to regulate the wire 4 from being twisted or bent in the L and Rdirection in the inside. 8 is an outer tube for passing the snare 3, theinner tube 7, and the pipes 5, 6 therein in a freely entering andexiting manner, and is made of a flexible plastic. The outer tube 8 hasan inner diameter greater than the outer diameter of the inner tube 7and the pipes 5, 6, includes a clearance S between the inner tube 7 andthe pipes 5, 6 to allow the inner tube 7 to freely move inside in the Land R direction and in the circumferential direction of the outer tube 8without bending. Due to such two tubes 7 and 8, the wire 4 is able tofreely move inside the outer tube 8 in the L and R direction and in thecircumferential direction without bending, and as hereinafter described,the force in the L and R direction and the rotational torque in thecircumferential direction transmitted from the remote control section 2to the wire 4 are transmitted from the wire 4 to the snare 3 withoutsubstantially no loss, thus allowing the snare 3 to smoothly move in theL and R direction and in the circumferential direction.

Next, in the remote control section 2, 9 shown in FIG. 1(a) is arod-shaped main body having a hollow inside, and a slit 9 a extending inthe longitudinal direction L and R of the main body 9 is formed on theside surface. Here, the rear end (R direction side) of the slit 9 a isopened, and thus the main body 9 is formed into a horseshoe shape. Asshown in FIG. 1(b), an inserting port 9 b for passing the pipe 6 insidethe main body 9 is formed at the front end (L direction side) of themain body 9. 10 is a cap attached to the front end of the main body 9,and the cap 10 passes the wire section 1 therein and holds the rear end8a of the outer tube 8 at a tapered part 9 c of the front end of themain body 9. The rear end 8 a of the outer tube 8 is opened in a hornshape so as to be easily held at the tapered part 9 c of the main body9.

11 is an operating member, and as shown in FIG. 5, hyperbolicpass-through holes 11 c, 11 d are formed therein. The main body 9 ispassed through the pass-through holes 11 c, 11 d, thereby slidablycoupling the operating member 11 to the main body 9 in the L and Rdirection. In FIG. 1(a), 11 a, 11 b are finger inserting holes to whichthe forefinger and the middle finger are inserted. 12 is a male jackcoupled to the operating member 11, and 12 a is a terminal of the jack12. The jack 12 is fitted to a female jack 13, and is thereby connectedto the high-frequency generator H by way of the cable C1. M is anexternal electrode attached to the abdomen or the buttocks of thepatient, and is connected to the high-frequency generator H by way ofthe cable C2. 14 is a finger holder coupled to the rear end of the mainbody 9, and a finger inserting hole 14 a to which the thumb is insertedis formed in the finger holder 14. When the thumb is inserted into thefinger inserting hole 14 a, and the forefinger and the middle finger areinserted into the finger inserting holes 11 a, 11 b of the abovementioned operating member 11, the operating member 11 is slide operatedin the L and R direction with the forefinger and the middle finger whileholding the main body 9.

In FIG. 3, 15 is a pinching mechanism built in the main body 9, and thepinching mechanism 15 is configured by a coupling member 16 for couplingthe rear end 6 a of the pipe 6 (FIG. 2) and the operating member 11, apair of clip members 17 coupled to the coupling member 16, and a slidingmember 18 sliding independently from the operating member 11 in the Land R direction. The coupling member 16 and the clip member 17 are madeof stainless steel and the slide member 18 is made of synthetic resin.The pinching mechanism 15 also functions as a rotating mechanism forrotating the wire 4 (FIG. 2) and the snare 3 (FIG. 2) coupled to thefront end of the wire 4.

A groove 16 a to which the rear end 6 a of the pipe 6 is inserted isformed at the front end of the coupling member 16, and the pair of clipmembers 17 is arranged in the vertical direction U, D of the groove 16a. The clip member 17 is configured from a plate spring of a shape shownin FIG. 6, and a flat part 17 a is coupled to a base part 16 b of thecoupling member 16 by a rivet 19. Further, a notch 17 d as shown in FIG.6(c) is formed at a pinching part 17c at the front end of the clipmember 17. The clip member 17 pinches the pipe 6 with the notch 17 d, ashereinafter described, and couples the pipe 6 to the coupling member 16.

In FIG. 3, a contacting part 16 c passing through a communicating hole11 e of the operating member 11 is formed on the R direction side of thebase part 16 b of the coupling member 16. As shown in FIG. 5, thecontacting part 16 c has a circular cross section, and contacts theterminal 12 a of the jack 12 by way of a spring 20. Thus, thehigh-frequency current flowing into the jack 12 from the high-frequencygenerator H is flowed through the terminal 12 a and the spring 20 intothe coupling member 16 from the contacting part 16 c. Further, as shownin FIG. 3, a threaded part 16 d is formed on the R direction side of thecontacting part 16 c. The threaded part 16 d is projected out from thecommunicating hole 11 e of the operating member 11 and is fastened by anut 21. The movement of the coupling member 16 to the L direction isregulated by the nut 21, but since the nut 21 is not fixed to theoperating member 11, the rotation of the coupling member 16 in thecircumferential direction is not regulated.

The sliding member 18 is, as shown in FIG. 3, arranged between an innerwall 11 f of the operating member 11 and a slanted part 17 b of the clipmember 17, and is biased in the L direction by a spring 22. The slidingmember 18 is exposed from the slit 9 a of the main body 9, as shown inFIG. 1(a) and FIG. 4, and thus can be sled to the L and R direction byoperating with the finger. Further, an accommodating space 18 a foraccommodating the clip member 17 is formed inside the sliding member 18.18 b is a projection provided at the front end of the accommodatingspace 18 a. When the sliding member 18 is sled in the L direction, thesliding member 18 is separated away from the inner wall 11 f of theoperating member 11, and the clip member 17 and the groove 16 a of thecoupling member 16 are interiorly accommodated in the accommodatingspace 18 a. Here, the slanted parts 17 b of the pair of clip members 17are pushed towards the coupling member 16 side by the projection 18 b,and each pinching part 17 c closes and overlaps. Further, a square hole18 c for passing the base part 16 b of the coupling member 16 having asquare cross section is formed inside the sliding member 18, as shown inFIG. 4. Thus, when the sliding member 18 exposed from the slit 9 a ofthe main body 9 is rotated with the finger with the axis of thelongitudinal direction L and R of the main body 9 as the rotationcenter, the coupling member 16 and the clip member 17 are integrallyrotated in conjunction therewith. A vertical and horizontal knurlmachining is performed on the surface of the sliding member 18, as shownin FIG. 1. The sliding member 18 is thereby easily rotated and sled.

The steps for resecting the polyp P formed at the wall W of theintestine and the operations of each part in the above mentionedpolypectomy instrument 100 will now be described with reference to FIG.7 through FIG. 9. FIG. 7 is a view explaining a coupling step of thewire section 1 and the remote control section 2, FIG. 8 is a viewexplaining a resecting step of the polyp P, and FIG. 9 is a viewexplaining a separating step of the wire section 1 and the remotecontrol section 2.

First, the wire section 1 and the remote control section 2 are coupledand the polypectomy instrument 100 is assembled. In FIG. 7(a), the wiresection 1 is first passed through the cap 10. Here, since the rear end 8a of the outer tube 8 is opened, the front end of the wire section 1 isinserted from the rear end (R direction side) of the cap 10. Next, thepipe 6 is inserted inside the main body 9 from the inserting port 9 b,and as shown in FIG. 7(b), the rear end 6 a of the pipe 6 is insertedinto the groove 16 a of the coupling member 16. Further, when thesliding member 18 is sled to the L direction, as shown in FIG. 7(c), theclip member 17 and the groove 16 a of the coupling member 16 areinserted in the accommodating space 18 a of the sliding member 18. Here,the slanted parts 17 b (FIG. 3) of the pair of clip members 17 arepushed towards the coupling member 16 side by the projection 18 b of thesliding member 18 and is displaced, and the pinching part 17 c (FIG. 3)is closed and overlapped thus pinching the pipe 6 between the pair ofnotches 17 d, and the pipe 6 is coupled to the coupling member 16. Theoperating member 11 and the wire 4 are thereby coupled by way of thecoupling member 16. Subsequently, when the cap 10 is attached to thefront end of the main body 9, and the rear end 8 a of the outer tube 8is held between the tapered part 9 c of the main body 9 and the cap 10,the wire section 1 and the remote control section 2 are completelycoupled, and the assembling of the polypectomy instrument 100 iscompleted.

Next, the polyp P formed at the wall W of the intestine is resectedusing the above polypectomy instrument 100. First, the jack 12 (shown inFIG. 1) of the operating member 11 and the jack 13 (shown in FIG. 1) ofthe high-frequency generator H are fitted together, and the externalelectrode M (shown in FIG. 1) is attached to the abdomen or the buttocksof the patient. The wire section 1 is then inserted into the intestineof the patient with the endoscope (not shown). Here, the operatingmember 11 is at a position of FIG. 7(c), and the snare 3 is retractedinside the outer tube 8. When the front end of the wire section 1 isinserted to a location where the polyp P is located, the operatingmember 11 is sled in the L direction, as shown in FIG. 8(a). Thecoupling member 16 and the pipe 6 are thereby pushed in the L direction,and thus the inner tube 7 and the wire 4 are also pushed in the Ldirection by such pushing force, and the snare 3 is projected out fromthe inside of the outer tube 8.

After the snare 3 is completely projected out from the inside of theouter tube 8, the snare 3 encircls the base Pa of the polyp P. Here, inFIG. 8(a), since the projecting direction (here, U direction) of thepolyp P and the loop surface of the snare 3 are parallel, even if thesnare 3 is moved in the D direction, the snare 3 does not encircle thepolyp P, and thus the sliding member 18 is operated with the fingers tobe rotated with the axis of the longitudinal direction L and R of themain body 9 as the rotating center. When the sliding member 18 isrotated, the coupling member 16 and the clip member 17 are integrallyrotated in conjunction therewith, and the rotational torque thereof istransmitted to the wire 4 through the pipe 6, and is transmitted fromthe wire 4 to the snare 3. Due to the rotational torque transmitted fromthe wire 4, the snare 3 is rotated in the same direction as the slidingmember 18. When the snare 3 is rotated in this way, the loop surface ofthe snare 3 becomes perpendicular to the projecting direction of thepolyp P and thus allows the snare 3 to encircle the polyp P, as shown inFIG. 8(b). Even if the coupling member 16 is rotated with the slidingmember 18, since the cross section of the contacting part 16 c of thecoupling member 16 is circular (FIG. 5), the contact of the couplingmember 16 and the terminal 12 a is maintained.

When the snare 3 encircles the polyp P, the high-frequency current isflowed from the high-frequency generator H through the wire 4 to thesnare 3. Here, as shown in FIG. 7(c), the pipe 6 is pinched by the clipmembers 17 and attached to the coupling member 16, and thus when thehigh-frequency current is flowed from the high-frequency generator H tothe cable C1, the high-frequency current is flowed through the jacks 12,13 and the spring 20 to the coupling member 17, and is flowed from thecoupling member 16 through the pipe 6 and the wire 4 to the snare 3. Thehigh-frequency current is thereby flowed from the base Pa of the polyp Pencircled by the snare 3 through the body of the patient to the externalelectrode M, and heat generation as well as burning occurs at the partof the polyp P with the smallest cross sectional area. Subsequently,when the operating member 11 is gradually sled in the R direction, thecoupling member 16 and the pipe 6 are pulled in the R direction, andthus the inner tube 7 and the wire 4 are also pulled in the R directionby the pulling force, and the snare 3 is gradually retracted to theinside of the outer tube 8. When the snare 3 is gradually retracted tothe inside of the outer tube 8, the base Pa of the polyp P is tightenedby the snare 3, as shown in FIG. 8(c). Finally, the base Pa of the polypP is burnt off by the burning by the high-frequency current and thetightening force of the snare 3, and the polyp P is resected from thewall W of the intestine. Subsequently, the cut off polyp P is naturallydischarged outside the body, or extracted outside the body by a separateremote controlled medical instrument in which a basket shaped graspingforceps serving as an actuator is coupled to the tip.

When the polyp P is cut off from the wall W of the intestine, theoperating member 11 is sled maximally in the R direction. The couplingmember 16 and the pipe 6 are thereby pulled in the R direction, and theinner tube 7 and the wire 4 are pulled in the R direction, and the snare3 is retracted to the inside of the outer tube 8.

Subsequently, the wire section 1 is pulled out from the intestine of thepatient. Further, the fitting of the jack 13 of the high-frequencygenerator H and the jack 12 of the operating member 11 is released, andthe external electrode M is also removed from the abdomen or thebuttocks of the patient. When the wire section 1 is pulled out of thebody, the sliding member 18 is sled in the R direction, and the clipmember 17 and the groove 16 a of the coupling member 16 are projectedout from the accommodating space 18 a of the sliding member 18, as shownin FIG. 9. Here, the slanted parts 17 b (FIG. 3) of the pair of clipmembers 17 are displaced to the main body 9 side by an elastic force ofthe clip member 17, thus causing the pinching part 17 c (FIG. 3) toopen, and the pipe 6 pinched between the pair of notches 17 d (FIG. 6)is released, and the pipe 6 becomes separable from the coupling member16. The cap 10 is removed from the front end of the main body 9, and asthe wire section 1 is pulled in the L direction, the rear end 6 a of thepipe 6 is broken away from the groove 16 a of the coupling member 16,and the operating member 11 and the wire 4 are separated. Further, whenthe pipe 6 is pulled out from the inside of the main body 9, the wiresection 1 and the remote control section 2 are completely separated.Subsequently, only the separated wire section 1 is discarded, and bycoupling a new wire section 1 again to the remote control section 2, theremote control section 2 can be reused.

When configured as above, the coupling and separation of the wiresection 1 inserted into the body of the patient and the remote controlsection 2 not inserted into the body of the patient can be freelycarried out, and thus only the wire section 1 is discarded and replacedwith a new one each time the surgery is performed and the remote controlsection 2 can be reused. As a result, a wasteful use of the entirepolypectomy instrument 100 can be eliminated, and the facility costnecessary for the surgery can be kept low. Further, with the slidingoperation of the sliding member 18, the clip member 17 detachablypinches the pipe 6 coupled with the wire 4, and the operating member 11and the wire 4 are coupled or separated by way of the coupling member16, and thus the attachment or detachment of the wire 4 to the operatingmember 11 can be easily carried out. Further, since the pinchingmechanism 15 configured from the coupling member 16, the clip member 17and the sliding member 18 also functions as a rotating mechanism forrotating the snare 3 coupled to the front end of the wire 4, therotating mechanism can be also reused by reusing the remote controlsection 2 each time the surgery is performed.

In the above mentioned embodiment, a case in which the wire 4 and theoperating member 11 are coupled or separated by way of the pipe 6 andthe coupling member 16 by detachably pinching the pipe 6 coupled to therear end of the wire 4 with the clip member 17 is given as an example,but the present invention is not limited thereto, and the wire 4 and theoperating member 11 may be coupled or separated by way of the couplingmember 16 by detachably pinching the rear end of the wire 4 directlywith the clip member 17. In this case, to easily pinch the rear end ofthe wire 4 with the clip member 17, the rear ends of the three singlewires configuring the wire 4 are preferably caulked with a short pipe oris subjected to machining such as connection by soldering.

In the above mentioned embodiment, a case in which the pinchingmechanism 15 configured from the coupling member 16, the clip member 17,and the sliding member 18 is adopted as a pinching mechanism fordetachably pinching the rear end of the wire 4 is given as an example,but the present invention is not limited thereto. The pinching mechanismmay also include, in addition, a mechanism in which a contactingterminal having an elastic force is embedded in the groove 16 a of thefront end of the coupling member 16 to detachably pinch the front end 6a of the pipe 6 to such contacting terminal, or a mechanism in which aclip terminal connected to the terminal 12 a of the jack 12 with a leadwire is coupled to the front end of the operating member 11 todetachably pinch the wire 4 directly with such clip terminal. That is,the mechanism may be of any kind as long as the rear end of the wire 4is detachably pinched, and the wire section 1 and the remote controlsection 2 are freely coupled or separated.

Further, in the above mentioned embodiment, the polypectomy instrument100 in which the snare 3 is coupled as the actuator for resecting thepolyp P of the stomach or the intestine is given as an example, but thepresent invention may be applied, in addition, to various remotecontrolled medical instruments such as, a body tissue collectinginstrument in which a bioptome equipped with a sharp blade is coupled asthe actuator for cutting and collecting the malignant or benign tissueof the body, and an internal foreign object extracting instrument inwhich a grasping forceps of for example, V-shape, a V-crocodile shape,open-mouthed shape, a basket-shape, a tripod-shape and the like iscoupled as the actuator to extract the foreign object taken inside thebody.

1. A remote controlled medical instrument comprising a wire sectioninserted into a body and equipped with an actuator for treating internalobjects at a front end, and a remote control section for controlling theactuator outside of the body; wherein the wire section includes, a wirecoupled with the actuator at the front end thereof; and a tube forpassing the wire and the actuator therein in a freely entering andexiting manner; and wherein the remote control section includes, arod-shaped main body having a hollow inside, an operating member,coupled to the main body so as to be slidable in a longitudinaldirection of the main body, for entering and exiting the actuator intoand from the tube by sliding, and a pinching mechanism, built in themain body and coupled to the operating member, for detachably pinching arear end of the wire.
 2. The remote controlled-medical instrument asclaimed in claim 1, wherein the pinching mechanism is configured by, acoupling member for coupling the operating member and the wire, a clipmember, arranged in the coupling member, for pinching the wire, and asliding member sliding independently from the coupling member in thelongitudinal direction of the main body; and wherein the clip memberpinches the wire in conjunction with the sliding of the sliding memberin one direction, and releases the wire in conjunction with the slidingof the sliding member in the other direction.
 3. The remote controlledmedical instrument as claimed in claim 1 or 2, wherein the pinchingmechanism is rotatably built in the main body with an axis of thelongitudinal direction of the main body as a rotating center, androtates the pinched wire and the actuator in conjunction with eachother.